RECRUITER pleaseadd Your Name, ServiceContact Number ______
Privacy Statement – please read and complete consent.
Any personal information you provide is protected under the Privacy Act 1988 and is collected for the purpose of your volunteering activities with Anglicare
or Anglican Ministry unit and may be used to inform you about your program, training or volunteering opportunities. It can only be disclosed to someone else if you have been given reasonable notice of the disclosure; where disclosure is authorised or required by law or is reasonably necessary for the enforcement of the criminal law; if it will prevent or lessen a serious and imminent threat to a person’s life or health; or if you have consented to the disclosure.
However, if you choose not to provide the information requested, we may not be able to process your application or properly consider you for a position.
If you have questions or concerns about how your personal information is handled you can contact the Privacy Officer at Anglicare by emailing:
Consent
I consent to my personal information being used or disclosed in the manner describe above. Yes No
Please tick box if you do not wish to receive;
- Anglicare Newsletters
- Information on Anglicare events & fundraising
- Diocesan/Ministry Notifications
This application must be completed by all applicants applying for Volunteerpositions in programs or services across Anglicare.
It can also be used for Parish Lay Workers in Parish Ministry Units of the Anglican Diocese of Canberra & Goulburn instead of the
Safe Ministry document.
Once all pageshave been completed, please return this form toyour recruiting officer or to Anglicare via:
MAIL: Anglicare Volunteer Manager, GPO Box 360, ACT 2601
EMAIL:
PHONE: (02) 6278 8400 FAX: 02 6278 8499 WEBSITE:
Please identify the name of the Program or Service you are interested in volunteering with:
Retail / Recycling Shop: Disaster Recovery/ACER: Specific Service or Program: Ministry Unit: Other:
Please detail:______
I AM APPLYING FOR A PARISH LAY MINISTER’S LICENCE
Yes A copy will be kept on file by theDiocesan ProfessionalStandards office No
-Surname: / Title:
-First Name:
-Previous Names:
-Residential Address: / Postcode:
-Postal Address: / Postcode:
-Telephone Contact: / Home: Mobile: Work:
-Email:
Name of Parish/Church affiliated with (if applicable)
Date of Birth:
Driver’s Licence: / Yes No Class:
Working with Children Check Number:
or Working with Vulnerable People Number: / Expiry Date:
Languagespoken - other than English:
First Aid Qualification(s): / First Aid: Yes No Exp: Mental Health First Aid: Yes No Exp:
CONTACT in case of EMERGENCY– details MUST be provided
Name: Relationship:
Best Contact Number:
VOLUNTEERING INFORMATION – for Anglicare research & reporting purposes
Reason for Volunteering: / Work/Study related Serving the Community
Personal Development Centrelink or Other Agency Requirement
Other:
Are you currently volunteering for any other Group? / Yes No If ‘Yes”, details:
How did you find out about this role? / Word of Mouth Anglicare Website Gumtree Twitter Facebook
Other Website (please name) Other
REFEREES – Immediate Family members will not be accepted as Referees.
Please supply the name, addresses (postal and email) and phone numbers of2 referees over the age of 18 years who are able to give a report of your good character and suitability for a position.For Parish Lay Worker Roles please include 3 Refereesincludinga referee from your last parish or placement in that state and/or country if you have recently lived elsewhere.
Referee (1): Employer or teacher (or person who has known you longer than 3 years, if no work or recent education history) / Name : Contact Number:
Address:
Email :
Referee (2):Person who has known you longer than 3 years and knows you well / Name : Contact Number:
Address :
Email :
Referee (3):For ParishLay Worker RolesOnly;Senior Church Leader – e.g. rector, church warden / Name : Contact Number:
Address :
Email :
RECORD OF CHRISTIAN CHURCH MEMBERSHIP
For Parish Lay Workers only – Record of Christian Church Membership –To be completed by those who have not been member of this ministry unit for more than 3 years. List any Church organisations, churches, parishes, or congregations (including your current one) that you have been a member of in the past 5 years. Add additional pages if necessary.
Church / Any Position Held / Location / Rector/Vicar/P-in-C / Start Date / End Date
WELL BEING & GOOD CHARACTER
Please tick either “YES” or “NO” for each question. Where a YES answer is given it will not automatically rule an applicant out of selection. However, in these situations the Application will be forwarded to the Safe Church Unit/Human Resources for assessment before an appointment can be made. Wherever a YES answer is given, please provide relevant information regarding your response on a separate paper and indicate the current status, of the issue, if any. / Please Tick
Yes or No
Fitness for Duty:Do you have any physical and/or mental condition(s) that may affect the tasks that you can perform and your ability to work safely? / Yes No
Criminal Matters:Have you ever been charged with or convicted of a criminal offence? / Yes No
Violence: Have you everbeen subject to an apprehended violence order? / Yes No
Traffic Matters:Have you ever had your driver’s licence suspended or cancelled? / Yes No
Misconduct or Reportable Conduct:Have you ever committed serious misconduct or had a complaint or allegation against you reported to a government agency such as the Police, Ombudsman’s Office or Department of Health and Ageing? / Yes No
Substances:Have you a history of alcohol abuse or a history of substance abuse including recreational or illegal drugs and misuse of prescription, over-the-counter medications? / Yes No
Harassment:Have you done anything in the past or present that may result in allegations being made against you of bullying or any form of harassment of adults? / Yes No
Suspension of Permission:Have you ever had permission to undertake paid or voluntary work with children, young people or vulnerable adults refused, suspended or withdrawn in Australia or any other country? / Yes No
Sexual Misconduct:Have you ever engaged in any of the following conduct, even though never having been charged?
- sexual contact with someone under your care other than your spouse (such as a parishioner, client, patient, student, employee or subordinate)
- sexual contact with a person under the age of consent
- illegal use, production, sale or distribution of pornographic materials
- Conduct likely to cause harm to a child, young person or vulnerable adult, or to put them at risk of harm.
Removal of Child:Has a child or dependent young person or vulnerable adult in your care (as a parent or in any other capacity) ever been removed from your care, or been the subject of a risk assessment by the authorities? / Yes No
Child Abuse:Have you done anything in the past or present that may result in allegations being made against you of child abuse?
Child abuse means; bullying; emotional abuse; harassment; neglect; physical abuse; or sexual abuse. / Yes No
Ethical Behaviour:Are you aware that Anglicare and Anglican Ministry Units expect high standards of ethical behaviour from all staff, lay workers and volunteers? / Yes No
Disclosure:Is there anything in your background that you have not disclosed in the application, which if it becomes public knowledge could adversely affect the assessment of your good name and character? / Yes No
Declaration:
Signature:
Date: / I hereby apply for aVolunteer or Parish Lay Worker role with Anglicare or Anglican Ministry Unitbelieving that the information I have provided is true and complete, and understand that my engagement may be terminated should it be subsequently found that this information is false, misleading or intentionally omitted.
- I declare that I am not
(b) a person who, if they were a resident in NSW, would be a prohibited person; or
(c) a person in respect of whom information has been entered on the National Register(ii); or
(d) a person who has been convicted of an offence punishable by more than 10 years imprisonment; or
(e) a person who has been convicted or found guilty of a sexual offence
- I understand that checks may be made to verify the above and hereby give permission for any background checks that may be necessary.
- If there are any changes in regard to the above I will notify the program/service manager or Rector of the Ministry Unit hosting the program.
- I make this declaration conscientiously believing it to be true and in accordance with the provisions of the Statutory Declarations Act 1959.
- a. Anglican Parish Lay Worker Roles;I have received a copy of the current edition of the Diocesan Code of Good Practice of the Anglican Diocese of Canberra & Goulburn and Safe Communities of Faith Policy and I agree to adhere to and implement these documents, including attending a Creating Safe Ministries workshop and Refresher sessions. OR
/ /
[i]
Form: / Volunteer/ Parish Lay Worker Application / Release Date: / January 2015Document Map: / Community Relations/Volunteering / Version: / 1
Authorisation: / Volunteer Manager / Pages: / Page 1 of 4
- A prohibited person is someone who is a registrable person as defined in the Child Protection (Offenders Registration) Act 2000 (NSW) or has been convicted of one of the following offences:
•murder of a child;
•serious sex offence, including carnal knowledge;
•child-related personal violence offence (an offence committed by an adult involving intentionally wounding or causinggrievous bodily harm to a child);
•indecency offences punishable by imprisonment of 12 months or more;
•kidnapping (unless the offender is or has been the child's parent or carer);
•offences connected with child prostitution;
•possession, distribution or publication of child pornography; or
•attempt, conspiracy or incitement to commit the above offences.
- The National Register is a register established by a canon of the National Anglican Church containing details of complaints of sexual misconduct or child abuse made against clergy and lay people which have been made to, or dealt with by, a church body.